Individual provider Active NPI

Mary B Becker, APRN

  • Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1952305807
Registry record updated May 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3002137 Issued in KY
Practice address
4121 Dutchmans LN
Plaza III, Suite 101
Louisville, KY 40207-4707
Phone
(502) 896-8660
Fax
(502) 896-5863
NPI assigned
Jun 9, 2005
Last updated
May 10, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3002137 KY Primary
Women's Health Nurse Practitioner 363LW0102X 3002137 KY

Addresses

Primary practice location

4121 Dutchmans LN
Plaza III, Suite 101
Louisville, KY 40207-4707

Mailing address

2700 Stanley Gault Pkwy
Ste 129
Louisville, KY 40223-5132
Phone (502) 253-4917

Other identifiers 1

IdentifierTypeStateIssuer
78021375MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3002137KYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Becker, LLC Women's Health PastSince Nov 14, 2010 Accepting new patients
Medifem Health, P.S.C. Women's Health Past Accepting new patients
Hubbard Clinic & Center for Bladder Control, LLC Past Accepting new patients
Resource Anesthesiology Associates of Ky PSC PastSince Sep 23, 2010 Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462838400000",
    "number": "1952305807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 STANLEY GAULT PKWY",
            "address_2": "STE 129",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235132",
            "telephone_number": "502-253-4917",
            "fax_number": "502-489-5751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 DUTCHMANS LN",
            "address_2": "PLAZA III, SUITE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074707",
            "telephone_number": "502-896-8660",
            "fax_number": "502-896-5863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKER",
        "first_name": "MARY",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3002137",
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "KY",
            "license": "3002137",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78021375",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.